Abstract
BACKGROUND: Empiric antifungal treatment is recommended in patients with suspected candidemia given the 20–40% associated mortality. T2Candida Panel (T2) is approved for the rapid detection directly on a blood sample of candidemia caused by C. albicans/C. tropicalis (CA/CT), C. parapsilosis (CP), C. glabrata/C. krusei (CG/CK). Our hospital implemented a candidemia management protocol utilizing T2 to identify candidemia in high-risk patients. We examine the potential for antifungal stewardship by analyzing T2 species-specific result-based antifungal de-escalation. METHODS: Retrospective analyses were conducted on 70 T2-positive patients identified in 2016–2017 at our hospital. The primary endpoint is time to de-escalation from echinocandin to fluconazole based on T2 species identified. Secondary endpoints included time to T2 positivity, and identification of risk factors for mortality. Univariate logistic regression was used to determine association between risk factors and mortality. Multivariate logistic regression models were created using forward selection to model the odds of mortality. Time to de-escalation of echinocandins was modeled using Kaplan–Meier estimators. RESULTS: In T2-positive results for CA/CT or CP, 50% of patients were de-escalated to fluconazole therapy within 96 hours. In T2-positive result for CG/CK, 50% of patients were de-escalated in 20 days (figure). The turnaround time (TAT) for T2 6 hours (3–12 hours). Overall mortality was 47% in the T2-positive cohort and was unchanged over the study period. Univariate analysis showed statistically significant associations between mortality and sepsis diagnosis, hypotension, abnormal WBC count, and tachycardia (P < 0.05). Multivariate analysis showed tachycardia, age, and presence of prosthetic devices, taken together, fit the best model to predict odds of mortality (P < 0.05). CONCLUSION: T2 proved useful in promoting de-escalation of echinocandin to fluconazole therapy in patients with fluconazole-susceptible Candida species. The rapid TAT of T2 promotes timely de-escalation of enchinocandins. Overall mortality in patients with suspected candidemia remains unaffected despite rapid diagnostics and early empiric antifungal therapy. DISCLOSURES: G. Alangaden, T2 Biosystems: Speaker’s Bureau, Educational grant and Speaker honorarium.